IMPORTANCE e-Cigarette, or vaping, product use-associated lung injury (EVALI) has caused more than 2800 illnesses and 68 deaths in the United States. Better characterization of this novel illness is needed to inform diagnosis and management. OBJECTIVE To describe the clinical features, bronchoscopic findings, imaging patterns, and outcomes of EVALI. DESIGN, SETTING, AND PARTICIPANTS This case series of 31 adult patients diagnosed with EVALI between June 24 and December 10, 2019, took place at an academic medical center in Salt Lake City, Utah. EXPOSURES e-Cigarette use, also known as vaping. MAIN OUTCOMES AND MEASURES Symptoms, laboratory findings, bronchoscopic results, imaging patterns, and clinical outcomes. RESULTS Data from 31 patients (median [interquartile range] age, 24 [21-31] years) were included in the study. Patients were primarily men (24 [77%]) and White individuals (27 [87%]) who used e-cigarette products containing tetrahydrocannabinol (THC) (29 [94%]). Patients presented with respiratory (30 [97%]), constitutional (28 [90%]), and gastrointestinal (28 [90%]) symptoms. Serum inflammatory markers were elevated in all patients. Bronchoscopy was performed in 23 of 28 inpatients (82%) and bronchoalveolar lavage (BAL) revealed the presence of lipid-laden macrophages (LLMs) in 22 of 24 cases (91%). BAL samples tested positive for Pneumocystis jirovecii (3 patients [13%]), rhinovirus (2 patients [8%]), human metapneumovirus and Aspergillus (1 patient each [4%]); all except human metapneumovirus were determined to be false-positives or clinically inconsequential. The exclusive or dominant computed tomography (CT) pattern was organizing pneumonia in 23 of 26 cases (89%). Patients received antibiotics (26 [84%]) and corticosteroids (24 [77%]), and all survived; 20 patients (65%) seen in follow-up showed marked improvement, but residual symptoms (13 [65%]), radiographic opacities (8 [40%]), and abnormal pulmonary function tests (8 of 18 [44%]) were common. CONCLUSIONS AND RELEVANCE In this case series, patients with EVALI characteristically presented with a flu-like illness with elevated inflammatory markers, LLMs on BAL samples, and an organizing pneumonia pattern on CT imaging. Bronchoscopic testing for infection had a high incidence of false-positive results. Patients had substantial residual abnormal results at early (continued) Key Points Question What are the typical clinical, radiographic, and bronchoscopic findings and clinical outcomes of e-cigarette, or vaping, product use-associated lung injury (EVALI)? Findings This case series of 31 patients found that EVALI typically presented as a flu-like illness with elevated inflammatory markers and an organizing pneumonia pattern on computed tomography imaging. Bronchoscopy showed lipid-laden macrophages and had a high rate of false-positive results for infection. Meaning The findings of this study suggest that EVALI has a characteristic clinical and radiographic presentation and that bronchoscopy has limited utility in its evaluation.
Among older adults, short-term ambient particulate matter less than or equal to 2.5 μm in aerodynamic diameter exposure is associated with more emergency department visits and hospitalizations for pneumonia, severe pneumonia, increased mortality, and increased healthcare costs. Nitrogen dioxide and ozone modestly increase pneumonia risk and illness severity.
Rationale: Aging is associated with reduced FEV 1 to FVC ratio (FEV 1 /FVC), hyperinflation, and alveolar enlargement, but little is known about how age affects small airways. Objectives: To determine if chest computed tomography (CT)assessed functional small airway would increase with age, even among asymptomatic individuals. Methods: We used parametric response mapping analysis of paired inspiratory/expiratory CTs to identify functional small airway abnormality (PRM FSA) and emphysema (PRM EMPH) in the SPIROMICS (Subpopulations and Intermediate Outcome Measures in COPD Study) cohort. Using adjusted linear regression models, we analyzed associations between PRM FSA and age in subjects with or without airflow obstruction. We subdivided participants with normal spirometry based on respiratory-related impairment (6-minute-walk distance ,350 m, modified Medical Research Council >2, chronic bronchitis, St. George's Respiratory Questionnaire .25, respiratory events requiring treatment [antibiotics and/or steroids or hospitalization] in the year before enrollment). Measurements and Main Results: Among 580 never-and eversmokers without obstruction or respiratory impairment, PRM FSA increased 2.7% per decade, ranging from 3.6% (ages 40-50 yr) to 12.7% (ages 70-80 yr). PRM EMPH increased nonsignificantly (0.1% [ages 40-50 yr] to 0.4% [ages 70-80 yr]; P = 0.34). Associations were similar among nonobstructed individuals with respiratory-related impairment. Increasing PRM FSA in subjects without airflow obstruction was associated with increased FVC (P = 0.004) but unchanged FEV 1 (P = 0.94), yielding lower FEV 1 /FVC ratios (P , 0.001). Although emphysema was also significantly associated with lower FEV 1 /FVC (P = 0.04), its contribution relative to PRM FSA in those without airflow obstruction was limited by its low burden. Conclusions: In never-and ever-smokers without airflow obstruction, aging is associated with increased FVC and CT-defined functional small airway abnormality regardless of respiratory symptoms.
for SPIROMICS investigators IMPORTANCE Few studies have investigated the association of long-term ambient ozone exposures with respiratory morbidity among individuals with a heavy smoking history.OBJECTIVE To investigate the association of historical ozone exposure with risk of chronic obstructive pulmonary disease (COPD), computed tomography (CT) scan measures of respiratory disease, patient-reported outcomes, disease severity, and exacerbations in smokers with or at risk for COPD.
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